Hi everybody and welcome back to my VLOG. So this week I'm going to talk about
something that a listerner that has asked me to do. So that subject is fibroids. And
lots of women suffer quite badly from fibroids, it really can be quite
debilitating. So I think it's a really good topic for us to cover.
So before we start, What is a Fibroid? Because many people won't know if they
haven't suffered. So a fibroid is a non cancerous growth inside the uterus (or
womb). It's made up of muscle and fibrous tissue. It's sometimes called a Leiomyoma
And they're various sizes, in various locations in and around the womb. And
they cause various different problems. So what causes a fibroid? So the answer to
that is, we're not really sure. We know that they are encouraged to grow by
oestrogen, one of the female sex hormones. And we know that the
more oestrogen a woman has, the more likely a fibroid will appear or grow.
They affect women of reproductive age because that's when they have those
hormones and that's when oestrogen levels are at their highest and
they shrink when oestrogen is low. So after we lose our oestrogen at
menopause. Although having said that, now that we're using more and more HRT
to treatment menopause, actually the lifespan of fibroids can go on and HRT
can actually encourage them to grow. So what are the symptoms? Well it's
important to know that often there are no symptoms. So we know that
between 30 and 50% of women who have fibroids actually get symptoms so that
means that between 50 and 70 percent have them but don't have any symptoms.
For 25% of women however, when they do get symptoms, as I said, those symptoms
can be really debilitating. And they can include pelvic pain, really heavy vaginal
bleeding (either during a period or that bleeding can just go on and on and on). So
women find themselves bleeding heavily for weeks. So as a result they can
actually get quite anaemic and they can have a lot of pain with that bleeding.
So their periods become more and more painful and then when
they're bleeding the pain is excruciating . They can get lower back pain.
They can actually get urinary frequency, so going to the toilet to pee far more
often. They can get constipation and that's because the fibroids are so big that
they're pressing on all of these other organs in the pelvis. There can be pain
during sex, making sex nearly impossible. And fibroids can actually lead to
infertility. So there are a lot of symptoms and they can be really far-reaching.
So who's at risk of getting fibroids, If someone can get them at some
women don't? Well they usually develop in women between the ages of 30 and 50,
But obviously women can get them before that. So some women get them very early
in their reproductive years and some women carry on with them after 50 and
long into menopause. Especially they're taking HRT. They're common; one in three
women will have Fibroids, it is just
lots of them don't know they have a fibroid. They're much more frequent in
women of afro-caribbean origin and they're also more common in women who
are overweight or obese. And the reason for that is that fat cells produce oestrogen.
And fibroids love oestrogen, they're actually oestrogen driven. So if you're
overweight, there's more chance of your fibroids being driven, growing or even
developing. They're lost less common in women who've had children and the more
children that you've had the less chance you have of getting fibroids. So what are
the types? And there are different types of fibroids. So essentially there are
three different types. And this is based on where they are in your uterus
or around your uterus. So these categories (and obviously there are
subcategories of these) but I won't go into those today. So the first
one is called intramural and this means in the muscle of the womb.
So in the muscle that surrounds the uterus and makes it up.
So these fibroids are in the wall of the uterus. These are the most common type
and they're quite often the less bothersome type. Then there are submucosal and that means
in the muscle layer beneath the inner lining of the womb. So on the very
surface, inside the womb and they grow into the uterus. So they actually grow
out and into the womb. So if you went inside the womb you could see those. And
then finally there's something called sub-serosal. And these are outside of
the womb of the uterus. So they're on the outside and they can grow really big and
of course because they're on the outside of the uterus they're growing into the
the pelvic cavity where your uterus is. And these are the ones that
press on the bladder, the ureters that carry the urine from the kidneys to the
bladder, and the bowel, causing constipation. And quite often pain.
If any of these fibroids are attached to wherever they are by a stalk (so there's
a little stalk before the fibroid grows) that's called a pedunculated fibroid. So
those are the types. How are they diagnosed?
This is always the question. Well quite
often if they're very large they can cause abdominal bloating and women
present to their GP's with symptoms that are being caused by these fibroids. And
that of course then eventually when we do our investigations involves them being
uncovered and discovered. Quite often, if you've got a very big fibroid that's
growing up into your pelvis, a GP will be able to feel your tummy and we'll be
able to feel the fibroid. And I actually diagnosed a woman, a young woman,
quite recently with what felt like what I called a 16-week uterus. So a uterus
that's got a baby of 16 weeks development inside it. And so I sent her
for an ultrasound and lo and behold that's exactly what she had. Often we
find them accidentally. So we send a woman for an ultrasound scan of her
pelvis to see something else; maybe pain, maybe irregular bleeding. and we find the
fibroids. And as I said, if we send someone for investigation for gynae
problems, be that bleeding/lack of periods/pain/
whatever, we find them then. If they're problematic we then move on to other
investigations, usually by gynaecology, and quite often an MRI will be done to
see exactly what their size is, look at them in 3D, see if they're encroaching on
other organs and how much damage they're doing in the pelvis. So the most
important question then is how do we treat them? Well if they're found
incidentally, so accidentally; we weren't looking for them, and we didn't suspect
them there because they weren't causing any problems, then leave them alone.
Watch and wait and see what happens. And nothing may happen, they
may not grow anymore they may never cause a problem. But if they are causing a
problem, there are lots of different treatments. And those treatments are
aimed at reducing the blood flow to the fibroids in the womb, pain relief, shrinking
the fibroids or removing them. And that's the broad categories of treatment.
So we normally start with pain relief or reducing menstrual flow. Because if
we can reduce the flow that often solves lots of the problems. So to reduce
menstrual flow we can use something called Tranexamic acid and this is a
tablet that will reduce the actual flow of your period by up to 50%. So that's
half, so that can be a really worthwhile exercise for many women, and be enough.
And you take it for three to four days when your bleeding starts. We often
suggest a mirena coil (an intrauterine system, IUS) and this stops the lining of the
womb building up and therefore reduces blood flow. And that can work
dramatically because in some women it stops blood flow completely. Now there
are some side effects of the Mirena coil and we've talked about that before; so
irregular bleeding can be a problem in the first six months but it usually
settles. You can get acne, breast tenderness, headaches. And some women
report mood swings. All of these things usually settle. So the Mirena coil is a
good solution if the fibroids are of a certain type.
So what I mean by that, is if they are distorting the shape of the uterus too
much then we won't be able to put a Mirena coil in, it will just be too difficult. So only
certain women can have the Mirena coil as a solution.
I mentioned pain relief, and these are usually non-steroidal anti-inflammatory
drugs (NSAIDs). So Ibuprofen or mefenamic acid, which you can get from your GP.
And they ease pain and they also reduce prostaglandins, and prostaglandins are
the hormones around the uterus at the time of our period and actually when
we're in labor that produce the pain. So we can reduce those to stop the pain and
that also sometimes reduces the bleeding as well. It can be taken with tranexamic
acid so quite often we give both and there are some side effects but they're
not massive; and they can be stomach upset and diarrhoea. The contraceptive
pill can be a good solution because it can ease the bleeding, regulate the
bleeding, and ease the pain. Progesterone taken orally, so by mouth, can thin the
lining of the womb and reduce bleeding and therefore pain. You take it on days
five to twenty six of your normal menstrual cycle. Side effects with this,
as with all tablets, are weight gain, bloating, breast tenderness and acne. But
again, these usually settle after the first few months. So that can be a good
solution. Injectable progesterone, so we call this depot, that you have once every 12
weeks, also thins the lining of the womb and helps reduce bleeding and pain. Side
effects with that one are weight gain, irregular bleeding, absent periods (which
can be a real bonus) and pre-menstrual symptoms like bloating, fluid
retention, breast tenderness. But again they can settle. The only thing to
remember about the depot injection is that if you are looking to get pregnant
it can delay your fertility by up to 12 months. So it's worthwhile thinking about
that. So the next step, if none of those are working, is to try and shrink a
fibroid. And we have a medication to do that called Goserilin. And it is a
Gonadotropin releasing hormone analogue. You need a referral to
gynaecology for this. This can't be done by your GP. Whereas all of the other
treatments that I have spoken about can be done by your GP.
It works on the pituitary gland, which is in the brain, and it stops the hormones
being sent to the ovaries to actually produce oestrogen and it actually brings
the menstrual cycle to a halt. So its sometimes used prior to surgery,
because if we starve the fibroids of oestrogen, they shrink. So it can be good
to shrink them so that your surgery is as least invasive as possible, because the
fibroids are as small as possible before we take them out. There are big
side effects to this drug. So you actually go into a menopause or chemical
menopause. So you can experience the hot flashes, the sweating, the vaginal dryness,
the muscle aches, the mental fogginess, everything. And sometimes they will use a
low dose HRT to actually try to help with those symptoms. Osteoporosis is also
a risk. You only use it for six months and you get a full return to fertility
when you stop using it. So it's important to know that it's a short-term solution
which can have big side effects, but they only last while you're on it. Now there
was a medication called ullipristal acetate. You may have heard of it and it
is still being used and it is still on the NHS website. However we're not using
this anymore for new patients, so you won't be offered this anymore.
Because there have been some severe cases of liver failure. So women who are
still on it; don't panic, speak to your doctor/ your gynae. You
should be having monthly liver function tests just to make sure that everything
is okay and there's more research being done into this at the moment. So if
you're on it it's fine - you need close monitoring. But it won't be started at
the moment, the jury is still out on this one. And then there is surgery. So surgery is
for severe symptoms that are just making life intolerable and if other treatments
have failed. And there are several methods used and
you'll decide with your surgeon which one is best for you.
So a myomectomy is where we actually take away the fibroids. We go in either
by an open cut in the tummy or via keyhole surgery and we take the fibroids
out of the wall of the uterus, or off of the wall. It's not suitable for
everyone. You do need a general anaesthetic and a
short hospital stay and there is a chance that the fibroids might grow
back. You can have what's called a hysteroscopic resection; so a small camera
and tools are inserted into the vagina then through the cervix and then into
the womb. Several insertions like that are needed,
as we keep going in and cutting away/burning away the fibroids. And it's
suitable for those submucosal ones. The ones I said you could see if you went
into the womb. And it does preserve fertility, so that's quite often the
reason that it's used. Usually it's done under a general anaesthetic, sometimes
under a local anaesthetic. You do go home the same day. You can get cramps and
very light vaginal bleeding which stops within a few weeks. There's a new process
now which is been used. Similar; goes in through the cervix into the womb and
it's called a morcellator. The benefit of this is that there's only one insertion
through the cervix and it minimises any chance of damage to the womb or the neck
of the womb. So that if you do want to go on to pregnancy you keep those risks
as low as possible. There isn't much evidence for it at the
moment because it's quite new and it's not offered everywhere but it is
something worthwhile talking about to you're gynae if that's the stage that
you're at. And then finally, probably the most dramatic, is a hysterectomy and this
is where we take away the uterus or the womb completely. So we remove the source
of the problem. You would only use this if your family's complete because you
would not be able to go on to have children. But it is the most effective
long-term solution and I've done a VLOG on hysterectomy, so if you want more
information about it just have a look at that VLOG. And it's
done through the vagina or an open cut in the tummy or through keyhole surgery.
It's done under general anaesthetic or spinal anaesthetic. It can push you into
early menopause if the ovaries are taken or affected, but oestrogen only HRT
can be used, although sometimes this can re-feed fibroids so this is another
discussion with your gynae. There are some non-surgical options. And so there's
one called uterine artery embolisation. So this is where we block the artery
that's feeding the fibroids and hopefully they will shrink. So a
radiologist does this and he does it under imaging so he can see what he's
doing and a dye is injected via the leg. And local anaesthetic is used. There's a
very short hospital stay. We don't know about the effects on fertility with that
one I'm afraid. There isn't enough evidence. You can have endometrial
ablation. This is where we remove the lining of the womb so that it can no
longer build up and no longer bleed. So it treats heavy bleeding. We use a heated
wire, loop wire or hot fluid inside the uterus or a laser. It's done under a local
or general anaesthetic. You can vaginal bleeding and cramps for up to four
weeks. And it's not recommended if your family's not complete because we can't
guarantee whether or not pregnancy would be sustainable in the future. There are
some newer techniques now, under MRI, but they are very new. So there's MRI guided
transcutaneous focused ultrasound. There's MRI guided percutaneous laser
ablation of fibroids. So this is needles into the fibroids under an MRI guidance
and either a laser or ultrasound beam is passed into the fibroid in order to kill
it and to shrink it. It's not suitable for
all fibroids and at the moment (again) the long-term effects are not known.
There isn't enough evidence, especially on women who want to have pregnancies in
the future. So the jury is still out on this one and it's not widely available
at the moment. Only in certain hospitals. So are there any alternatives?
Well there are lots that are suggested and I can't vouch for them because there
is no evidence. But the kind of things that I've read up about are decreasing
inflammatory foods; so cutting out caffeine, alcohol, processed food.
Decreasing environmental hormones; so red meat and dairy that's got oestrogen
hormones inside them, so as not to feed the fibroids. Increasing anti-inflammatory
foods so; whole fibre, leafy green vegetables, supplements, organic foods.
So basically a healthy lifestyle! Essential oils are out there
to try and treat fibroids. Acupuncture has been used and there is a lot of
evidence behind acupuncture, but not in particular to fibroids, but certainly
it's something worth considering. Exercise is essential for all pelvic
issues and pain. And hormonal approaches; so there are doctors out there who use
bioidentical hormones to treat all pelvic problems in women and again I
don't have the evidence for this. But they feel that if you balance up the
hormones, instead of being an oestrogen driven environment, a balance
will actually help shrink the fibroids. So as I said, I don't have evidence for those but I
will put a link to a natural site. I can't vouch for the validity of the site either.
But I will put it in afterwards because I think
it's always, my aim, is to give you the option so that you can do your
own research. I will put some information about the different solutions that I
suggested today that are available on the NHS and the NHS website on fibroids.
So I hope that's helped and it is a big topic that we've rushed through. Don't
forget to look at the hysterectomy one if that's something you're considering.
And hopefully this will enable you to ask me any questions afterwards as
always and I will answer them to the best of my knowledge. And at least arm
you with the information that you need to go to your doctor to discuss your
individual issues. So as ever, thank you so much for watching and don't forget to
ask me questions or suggest future topics.
See you soon!